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Rachel Naomi Remen

The Difference Between Fixing and Healing

Rachel Naomi Remen’s lifelong struggle with Crohn’s disease has shaped her practice of medicine, and she in turn is helping to reshape the art of healing. “The way we deal with loss shapes our capacity to be present to life more than anything else,” she says. And each of us, with our wounds and our flaws, has exactly what’s needed to help repair the part of the world that we can see and touch.

Guest

Rachel Naomi Remen is founder of the Remen Institute for the Study of Health and Illness (RISHI), clinical professor of family medicine at UCSF School of Medicine, and professor of family medicine at the Boonshoft School of Medicine at Wright State University. Her books Kitchen Table Wisdom and My Grandfather's Blessings have been translated into 24 languages.

Transcript

Krista Tippett, host: Rachel Naomi Remen is one of the wise people in our world. I quote from my conversation with her all the time. She’s a physician and a lyrical writer whose long struggle with Crohn’s disease has shaped her view of life and medicine. Living well, she says, is not about eradicating our wounds and weaknesses but understanding how they complete our identity and equip us to help others. The way we deal with losses, large and small, shapes our capacity to be present to all of our experiences. There’s a difference, she says, between curing and healing.

Rachel Naomi Remen: We thought we could cure everything, but it turns out that we can only cure a small amount of human suffering. The rest of it needs to be healed, and that’s different. I think science defines life in its own way, but life is larger than science. Life is filled with mystery, courage, heroism, and love — all these things that we can witness but not measure or even understand, but they make our lives valuable anyway.

[music: “Seven League Boots” by Zoë Keating]

Ms. Tippett: I’m Krista Tippett and this is On Being. Dr. Rachel Naomi Remen’s beloved books Kitchen Table Wisdom and My Grandfather’s Blessings have been translated into 24 languages. This gem of a conversation happened in 2005.

Ms. Tippett: You grew up, as you say, “surrounded by doctors and one mystic.”

Dr. Remen: Doctors, a few nurses, and one mystic. [laughs] It’s true.

Ms. Tippett: And that would’ve been your orthodox rabbi grandfather.

Dr. Remen: And student of kabbalah.

Ms. Tippett: Student of kabbalah before it was a fashion trend.

Dr. Remen: Very much so. [laughs] And he was a flaming mystic, and he was also a magnificent storyteller.

Ms. Tippett: Well, what do you mean when you say he was a “flaming mystic”? Describe that to me.

Dr. Remen: Oh, it means many different things. It can mean a scholarly thing, like the study of a school of mysticism like kabbalah. But it’s also a way of seeing the world. My grandfather felt that the world was in constant communication with him, that there was a spirit in the world, a God, in the world, that could be spoken to and could respond at all times, that there was a presence in the world that was holy and sacred, and that he was in constant dialogue with this as he went through the events of his day. I think mysticism can be defined in many different ways. I didn’t know that my grandfather was a mystic. I just knew that the world that he lived in was the world I wanted to live in too.

Ms. Tippett: You recount this idea of the kabbalah, which I had known, but, I think, maybe because you’re a storyteller, it was very vivid for me — this idea that at the beginning of creation, the holy was broken up. Right?

Dr. Remen: Oh, the story of the first day of the world. [laughs]

Ms. Tippett: Flew into sparks at the beginning of things.

Dr. Remen: The story of the birthday of the world, yes.

Ms. Tippett: Is that how he told it to you?

Dr. Remen: Yes, exactly.

Ms. Tippett: And how would he describe it?

Dr. Remen: Actually, Krista, this was my fourth birthday present, this story. And if you’d like, I’ll tell it to you.

Ms. Tippett: Yes, do.

Dr. Remen: This is the story of the birthday of the world. In the beginning, there was only the holy darkness, the Ein Sof, the source of life. Then, in the course of history, at a moment in time, this world, the world of a thousand thousand things, emerged from the heart of the holy darkness as a great ray of light. And then, perhaps because this is a Jewish story, there was an accident. [laughs] And the vessels containing the light of the world, the wholeness of the world, broke. And the wholeness in the world, the light of the world, was scattered into a thousand thousand fragments of light. And they fell into all events and all people, where they remain deeply hidden until this very day.

Now, according to my grandfather, the whole human race is a response to this accident. We are here because we are born with the capacity to find the hidden light in all events and all people; to lift it up and make it visible once again and, thereby, to restore the inate wholeness of the world. This is a very important story for our times — that we heal the world one heart at a time. This task is called “tikkun olam” in Hebrew, “restoring the world.”

Ms. Tippett: Is there a connection between the story of the sparks and tikkun olam in Jewish tradition? Are they bound together?

Dr. Remen: They’re exactly the same.

Ms. Tippett: I did not know that those two come together.

Dr. Remen: Tikkun olam is the restoration of the world. And this is, of course, a collective task. It involves all people who have ever been born, all people presently alive, all people yet to be born. We are all healers of the world.

And that story opens a sense of possibility. It’s not about healing the world by making a huge difference. It’s about healing the world that touches you, that’s around you.

Ms. Tippett: The world to which you have proximity.

Dr. Remen: That’s where our power is. Many people feel powerless in today’s situation.

Ms. Tippett: When you use a phrase like that, just out of nowhere, “heal the world,” it sounds like a dream — a nice, sweet ideal, completely impossible.

Dr. Remen: It’s a very old story. It comes from the 14th century. It’s a different way of looking at our power. And I suspect it has a key for us in our present situation, a very important key.

Ms. Tippett: Say some more about that. Think that through for me.

Dr. Remen: Well, I don’t want to talk politics here. I’m not a person who is a political person in the usual sense of that word. But I think that we all feel that we’re not enough to make a difference; that we need to be more, somehow, either wealthier or more educated or, somehow or other, different than the people we are. And according to this story, we are exactly what’s needed. And to just wonder about that a little, what if we were exactly what’s needed? What then? How would I live if I was exactly what’s needed to heal the world? I think these kinds of questions are very important questions.

Ms. Tippett: And exactly what’s needed is, precisely, the given story of your life.

Dr. Remen: Exactly. People will say, about a story like the story of tikkun olam, the birthday of the world, “Well, how can I make a difference when I’m so wounded, myself? How can I make a difference when I feel so not-enough?” But it’s our very wounds that enable us to make a difference. We are the right people, just as we are.

For example, my own wounds, my own sufferings, have enabled me to feel compassion for the sufferings of others. Without my suffering, I wouldn’t understand the suffering of others or be able to connect to them. My loneliness enables me to recognize the loneliness in other people, even when it’s covered over; to find them where they have become lost in the dark, and sit with them; and to know that just by sitting with them, eventually they will find what they need in order to move forward.

There’s another story in my family. My grandmother — my grandfather’s wife, the rebbetzin — in Russia they were quite poor, and they often fed members of the community. Being the rabbi’s home, people came there. So my grandmother was used to making things stretch and go a long way. And in this country, her icebox was filled with food, when they came over to America, because she had been hungry in Russia. The kitchen was the center of the house. The icebox was filled with food. Every nook and cranny was full to the brim. And it was told, in my family, that if someone opened the door of the icebox without caution, an egg might fall out and break on the kitchen floor. [laughs] And my grandmother’s response to these accidents was always the same. Apparently, she would look at the broken egg with satisfaction and say, “Aha. Today, we have a sponge cake.”

Ms. Tippett: [laughs] Oh, that’s good.

Dr. Remen: And so perhaps this is about our wounds. The fact is that life is full of losses and disappointments, and the art of living is to make of them something that can nourish others.

And when I first was diagnosed, I was 15 years old.

Ms. Tippett: With Crohn’s disease?

Dr. Remen: Yeah. And the doctors came and told me that I had this incurable disease. Nobody knew what caused it. I would have multiple surgeries, and I could expect to be dead by the time I was 40. Not my dream of the future as a 15-year-old. I went into shock. My mother was with me. And she did not comfort me or cuddle me. She took my hand, and she reminded me of this story. And she said, “Rachel, we will make a sponge cake.” And it’s taken me a long time to find the recipe that’s mine — my own recipe for this; but I had a sense of what might be possible and that I needed to look, to find the way for myself. And that’s what a story can do.

Ms. Tippett: I want to turn a corner, but before I do, I want to tell you a story.

Dr. Remen: Oh, good.

Ms. Tippett: I went home having all this in my head and my son, who’s seven, has something of a mystical bent — children do in a way — he’s got a lot of depth, and he’s thinking hard, and I told him this story about the beginning of the universe about the sparks and the holy flying out. And he just listened to me so raptly, and he said, “I like that.”

Dr. Remen: I was told this story 63 years ago. And my response to it was exactly the same. That’s very important about stories. They touch something that is human in us and is probably unchanging. Perhaps this is why the important knowledge is passed through stories. It’s what holds a culture together. Culture has a story, and every person in it participates in that story. Story, and not facts, are the way the world is made up. The world is made up of stories; it’s not made up of facts.

Ms. Tippett: Although we tell ourselves facts to piece together the story.

Dr. Remen: Well, the facts are the bones of the story, if you want to think of it that way. The facts are, for example, that I have had Crohn’s disease for 52 years. I’ve had eight major surgeries. But that doesn’t tell you about my journey and what’s happened to me because of that, and what it means to live with an illness like this and discover the power of being a human being. Whenever there’s a crisis, like 9/11, do you notice how the whole of the United States turned towards the stories?

Ms. Tippett: You mean, “Where I was…”

Dr. Remen: Where I was, what happened, what happened in those buildings, what happened to the people who were connected to the people in those buildings. Because that is the only way we can make sense out of life, is through the stories. The facts are a certain number of people died there, but the stories are about the greatness of being a human being and the vulnerability of being a human being.

Ms. Tippett: I think you make such an interesting contrast also with the fact that we live with all kinds of stories in our culture, forms of entertainment as well as information, but that those stories always have beginnings and endings. You say that the stories of our lives, stories as they function in life, take time. Real stories take time.

Dr. Remen: There’s a powerful saying that we tell each other stories — sometimes we need a story more than food in order to live. They tell us about who we are, what is possible for us, what we might call upon. They also remind us we’re not alone with whatever faces us and that there are resources, both within us and in the larger world and in the unseen world, that may be cooperating with us in our struggle to find a way to deal with challenges. When I say a story doesn’t have an ending, for example, part of my story is you telling your little boy the story of the birthday of the world. That’s also part of my grandfather’s story, right? And your little boy has never met my grandfather, but perhaps my grandfather will be woven into his life in some way. It may be a very small way or it may not, I don’t know, but in that sense no one’s story is ever finished.

[music: “Pianoflikkan” by Nutid]

Ms. Tippett: I’m Krista Tippett and this is On Being. Today with Dr. Rachel Naomi Remen.

Ms. Tippett: Did you train also as a psychiatrist?

Dr. Remen: No.

Ms. Tippett: But you have really become a professional listener, as well as a physician, haven’t you? Is that fair?

Dr. Remen: Well, I would say, yes, I’m trained, but I have no credentials. I have spent, I would say, 3,000 hours in humanistic psychology workshops, learning various techniques — imagery, symbol work, sand tray work, poetry, art — anything that would enable people to discover the strength in them, discover who they are. So I have a very extensive training, but I don’t have a degree in psychology or psychiatry. I have taught in schools of psychology; I’ve taught health psychology and all of this. But I am a physician; I am an M.D.

Ms. Tippett: It seems to me that you, at the same time, have had a medical practice, worked as a physician, specializing, I believe, in working with people who have cancer. Is that right?

Dr. Remen: Yes. I think I’ve made very few decisions in my life. It’s like I find myself in a situation, and it’s very clear what the next step is. [laughs] And I take that step, and I think this is basically my modus operandi for leading my life. We had grants to study the doctor/patient relationship. Then a new administration came in, and we couldn’t get the final piece of funding to finish this work. And I spent six months writing grants and then ran out of money. And people had been calling me up — because I’d been writing about these things — and saying, “Can I come and talk to you about my problem?” And I’d say, “No, no, no. I don’t do that. I’m not a psychologist. I’m not a psychiatrist. I don’t do that.” These are people, sick people, friends, friends of friends, all sorts of people. Then when I ran out of money I said, “Well, I guess I do this.” So I found a little office on a houseboat in Sausalito, the first office, and a few people came by. And I decided I would go and speak to my colleagues in the medical community and tell them that I wanted to work with sick people and with their emotional issues and their struggle to live with disease and also to recover from disease. And most of the physicians in the community said, “Terrific. Who has the time to talk to these people? Once I run out of treatments I have nothing more to offer anyone.” That’s another whole story in and of itself, of course — and “Let me send you over my patients.” And within months, I had a completely full practice and most of the people were people with cancer, and I began to work as a person who focused my efforts on working with people with cancer.

Ms. Tippett: Why do you think that most of the people your colleagues ended up sending you were people with cancer? Was that a particular life experience that they weren’t equipped to handle in its fullness?

Dr. Remen: The hospice movement is fairly recent in all of this.

Ms. Tippett: OK. So this was before hospice.

Dr. Remen: This is before that. I mean, you knew how to treat the cancer. That’s what we were trained to do in medical school. We’re trained differently now. The issues of the person with the cancer was something that — we would refer people to psychiatrists. But these aren’t people who have psychological illness. These are people who are confronted with a very challenging life situation and who need to mobilize their full strength and the strength of their families in order to meet with these things, to live well despite cancer.

Ms. Tippett: As you say, you probably didn’t plan this. I’m sure you didn’t plan this. But what you said earlier about how we’re all given the lives we have and that that’s good enough, and even what’s wrong with us is part of what we have, it seems like it’s been really important in your medical practice — and also in how you’ve helped other physicians, how you’ve reflected on your profession — that you also have struggled in your life with this debilitating illness of Crohn’s disease, which you were told was fatal earlier.

Dr. Remen: But, Krista, I don’t think it’s what’s wrong with us. Sometimes what appears to be a catastrophe, over time, becomes a strong foundation from which to live a good life. It’s possible to live a good life even though it isn’t an easy life. And I think that’s one of the best-kept secrets in America.

Ms. Tippett: You say that the pursuit of perfection has become a major addiction of our time. We throw that word “addiction” around a lot, but I’ve never heard anyone talk about our pursuit of perfection as an addiction.

Dr. Remen: Well, I think perfection is the booby prize in life, actually. It’s very isolating, very separating, and it’s also impossible to achieve. So you’re always struggling to become something you’re not. But, this is — it sounds funny — one of the great joys of working with people on the edge of life. The view from the edge of life is so much clearer than the view that most of us have, that what seems to be important is much more simple and accessible for everybody, which is who you’ve touched on your way through life, who’s touched you. What you’re leaving behind you in the hearts and minds of other people is far more important than whatever wealth you may have accumulated.

Ms. Tippett: Now, what is your understanding of why that simple truth that we’ve all heard said — and it makes so much sense — why is that hard for us, for human beings to take seriously before we get to that edge of life, for many of us?

Dr. Remen: I think we get distracted. We get distracted by stories other people have told us about ourselves, that we are not enough, that we will be happy if we have material goods, that material goods will keep us safe. None of these stories are true. What is true is that what we have is each other.

And this is why I see people with cancer and other people who have encountered very difficult experiences in their lives as teachers, teachers of wisdom. It’s as if the wisdom to live well is — at the moment, the repository of this wisdom are the sick people in our culture, the ill people in our culture.

[music: “Alice” by Grandbrothers]

Ms. Tippett: After a short break, more with Rachel Naomi Remen. We’re putting all kinds of great extras into our podcast feed. Lots of poetry, music, and a new feature “Living the Questions.” You can get it all as soon as it’s released when you subscribe to On Being on Spotify, Google Podcasts, Apple Podcasts, or wherever you like to listen.

I’m Krista Tippett and this is On Being. Today with the wise physician and lyrical writer Rachel Naomi Remen. Her lifelong struggle with Crohn’s Disease shaped her practice of medicine, and she in turn has changed the art of healing and medical training. We’re exploring what she knows about the difference between healing and curing; and how our losses actually help us to live.

Ms. Tippett: What have you learned through your work with other physicians, your attempt to listen to other physicians and to work on the healing of the field of medicine? How did that come about, that you started doing that, actively?

Dr. Remen: Well, again, the next step appears. [laughs] In listening to the people with cancer at the retreats, I would hear stories about their experience with the medical system and with the people in it. And every so often, someone would go back and tell their doctor what they had experienced at the retreat, and the doctor would call. And I was the medical director; I am the medical director, still, of the retreat. And the doctor would say, “Aren’t you doing anything like this for us?” [laughs]

And I began to realize how wounded I had been by my training. The training is abusive. It’s a very difficult experience, medical school and training. It’s 24/7; it goes on for years, seven, eight years. And I began to realize how I had been healed by these people with cancer; how I had moved from a person focused on curing, and truly coming to understand that we are all healers of one another; that people have been healing each other since the beginning and that my power to cure was a small part of my power to help people.

And wanting to help my profession, as well. The people who go into medicine are extraordinary. I developed a course called “The Healer’s Art” — gosh, that was 1992. And I taught it as UCSF. It’s a very unusual course. It’s an experiential course. You usually don’t do these things — certainly, not back then in medical school. It’s about enabling young people to recognize that who they are is as important as what they know, in terms of what they’re going to be able to make a difference in people’s lives.

It is validating for students, the human agenda in illness. It reminds them that healing is a different relationship than a curing relationship. It reminds them of their power to make a difference through their human response and connection to their patients. It basically reminds the students of the lineage of medicine. I happen to see medicine as a spiritual path. That’s my personal thing, that medicine is a spiritual path, which is characterized by compassion, harmlessness, service, reverence for life, courage, and love.

The basic qualities of the Hippocratic Oath are not scientific qualities. They are the qualities of human relationship, and they are very profound spiritual qualities. And we remind the students of the lineage — this is young students — and we enable them to see that they belong to it exactly as they are, that they are already the right people to become physicians. All they need to do is learn the science and learn the facts, without allowing themselves to be changed by that process in any way.

Ms. Tippett: What is it in that process — the stories you tell about how destructive medical school can seem ironic. We do think of people who go to medical school, as you say, as extraordinary.

Dr. Remen: They are.

Ms. Tippett: People who are giving themselves over to this profession that is about healing. And what you describe is an experience that is…

Dr. Remen: We learn how to cure. Now, that is changing. Obviously, 10 years ago this course would not be in any of these schools. UCSF was forward-looking enough to give it a home. But I think the world is changing. I think we’re recognizing the limitations of our science. That little phrase, “living better through science,” there’s no question that we live better through science. But to live well is going to take something more than that. If I look at myself without the eight major surgeries and the many medications — and I still take many medications that keep me alive — I wouldn’t be here. But with only these things, I’d be an invalid.

Ms. Tippett: Right. I wanted to ask a minute ago when you said you think about medicine as a spiritual path, and yet medicine is also a science, at least in our culture, and it seems that at some point somehow the science overwhelmed — or the scientific mindset, even among those of us who are outsiders, how we view science overwhelmed whatever spiritual element there is in that.

Dr. Remen: Well, you have to understand how natural that is. I’ll tell you about myself. When I was a child, I had severe otitis media…

Ms. Tippett: An ear infection.

Dr. Remen: …and developed an abscess in the bone of my skull, and sulfa drugs were available in the nick of time. That power was a very heady power. There was insulin for people with diabetes. You have to think about what this meant for people.

Ms. Tippett: You’ve seen all this in your lifetime.

Dr. Remen: Oh, my God. Yes. This meant a huge amount for people. We thought we could cure everything, but it turns out that we can only cure a small amount of human suffering. The rest of it needs to be healed, and that’s different. I think science defines life in its own way, but life is larger than science. Life is filled with mystery, courage, heroism, love — all these things that we can witness but not measure or even understand, but they make our lives valuable anyway.

Ms. Tippett: The destructive aspects of life are also mysterious and unmeasurable, right? We can also observe evil.

Dr. Remen: Of course that’s true. But the issue is not to eradicate evil. I’m not sure evil can be eradicated. I think it’s part of the human condition. The issue is to commit yourself to what’s important to you.

Ms. Tippett: You question the term “objectivity,” that is part of a scientific framework. As a journalist, I’ll say, it’s a value that’s been held up in many disciplines in our culture. And it’s coming into question in many disciplines; “Is it enough?” Or, “Are we kidding ourselves when we say we’re objective?” And if we’re kidding ourselves, then do we need to look at it all over again?

Dr. Remen: Objectivity’s cognitive in a funny kind of way, isn’t it?

Ms. Tippett: Right.

Dr. Remen: But the thing that seems important is that in order to understand life we need to look at it through many different dimensions. Sometimes we understand another person the best and know how to help them the best when we are not objective.

Ms. Tippett: Well, there’s another simple statement for you, but we don’t always act on it.

Dr. Remen: But look, objectivity is a bias like anything else. I mean, the funniest story in Kitchen Table Wisdom — this happened at Sloan Kettering many years ago when I was an intern, first-year doctor. We had a man come into the hospital to die. People used to come into the hospital to die. There wasn’t a hospice movement then. If your care was too difficult to achieve at home, you were admitted to the hospital to die. And this man came in riddled with cancer. He had an osteosarcoma, and his bones looked like Swiss cheese; all these lesions were cancer, and there were big snowballs of cancer in his lungs. And in the two weeks or so that he was with us in the hospital, all of these lesions disappeared, and they never came back, Krista.

Now, were we in awe? Certainly not. We were frustrated. Obviously someone had misdiagnosed him. So we sent the slides out to pathologists all over the country, and the pathologists sent back the slides saying classic osteogenic sarcoma. So then we had a grand rounds, and the slides were shown, the X-rays were shown, the man himself was shown. And the conclusion of this large group of doctors was that the chemotherapy, which had been stopped 11 months before, had suddenly worked.

Now, the embarrassing part of this story is that I believed this. For the next 15 years, I never questioned this conclusion. I think too great a scientific objectivity can make you blind.

Ms. Tippett: What do you think now?

Dr. Remen: I think that that was one of the purist encounters with mystery that I have ever had in my life. It makes me wonder about who we are, what’s possible for us, how this world really operates. I have no answers, but I have a lot of questions, and those questions have helped me to live better than any answers I might find.

[music: “Hem” by Tvärvägen]

Ms. Tippett: I’m Krista Tippett and this is On Being. Today with Dr. Rachel Naomi Remen.

Ms. Tippett: Something that I found interesting when you write about working with physicians — you try to make them comfortable with loss and to understand that as a part of their jobs, their lives, their working lives. But again, you’re talking about physicians, but you end up making interesting observations that apply to all the rest of us, about loss. Talk to me about what you’ve learned about loss.

Ms. Tippett: Well, alright then. Here’s the sentence that I wrote down: “The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life.”

Dr. Remen: I think this is absolutely correct.

Ms. Tippett: That is such a shocking thought, really.

Dr. Remen: I think it’s correct. I also think that no one is comfortable with loss. Being that we’re a technological culture, our wish or our first response to loss is try and fix it. When we are in the presence of a loss that cannot be fixed, which is a great many losses, we feel helpless and uncomfortable and we have a tendency to run away, either emotionally or actually distance ourselves. And fixing is too small a strategy to deal with loss. What we teach the students is something very simple.

Ms. Tippett: The medical students?

Dr. Remen: Yeah. We teach them the power of their presence, of simply being there and listening and witnessing another person and caring about another person’s loss, letting it matter. We do six hours on loss, two three-hour sessions, and the students have a very simple instruction, which is, they are asked to remember a story of loss from their own lives, and loss — let’s put it differently — a time when things didn’t go their way, when they were disappointed, when they lost a dream or a relationship or even a family member, a death.

They get to choose that, and then they spend six hours in small groups talking about their loss. And the group has one instruction: Listen generously. Now, prior to this exercise, we do another exercise with them where we ask them to remember a time of disappointment and loss and to remember someone who helped them. What did that person do? What did they say? What message did they deliver that was helpful to them at a hard time in their lives? And they write these things down very concretely. Then we ask them to remember a time of loss in their lives and remember someone who wanted to help them but was not of help to them. What did that person do and say, and what message did they deliver, and how did they deliver the message? And they write that down.

And then we make a big list. “What are all the things that helped?” “Listened to me for as long as I needed to talk.” “Talked to me in the same way after my loss as they did before my loss.” “Sat with me.” “Touched me.“ “Brought me food.” What were the things that didn’t help? “Gave me advice without knowing the full story.” “Made me feel that the loss was my fault.” So we gather up the wisdom about what helps loss to heal from a group of about a hundred students and faculty, and it’s all very simple stuff. And the only instruction is: Listen generously.

Ms. Tippett: Again, it takes me back to how we began talking about the power of stories in human lives, and your analogy that the stories are the flesh we put on the bones of the facts about our lives. I think it’s so powerful just to think about this obvious fact, but again one of these obvious facts we don’t name very often, that loss is not just catastrophic death. There are many different kinds of losses in our lives all the time, and then this kind of stunning idea that you bring forth that the way we deal with those losses, large and small, can really help or get in the way of the way we deal with the rest of our lives, with what we have. Not just what we’ve lost.

Dr. Remen: I think this is so. I really do. How do I put this? Most people try to hold on to the thing that is no longer part of their lives, and they stop themselves in their lives in that way. I have come to see loss as a stage in a process. It’s not the bottom line. It’s not the end of the story. What happens next is very, very important. And people respond to losses in different ways. When I first became ill, I was enraged. I hated all the well people. I felt that I was a victim and this was unfair. I was angry for about 10 years. I think all of that anger was my will to live expressed in a very negative way.

People often are angry in the setting of a terrible loss. They often feel envious of other people, and this is a starting place. But over time things evolve and change. And at the very least, people who have lost a great deal can recognize that they are not victims, they are survivors. They are people who have found the strength to move through something unimaginable to them, perhaps, in the past. And just asking people that question: “You have suffered a really deep loss. What have you called upon for your strength?” Most people haven’t even noticed their strength. They’re completely focused on their pain.

Ms. Tippett: On their loss.

Dr. Remen: On their pain. And isn’t that natural, Krista?

Ms. Tippett: There’s something very hopeful all the way through your writing, even when it is about loss and the hard, dark side of being human. I mean, you do insist — and I’m not sure that modern psychiatry insists on this — that integrity is achievable for everyone, that you see it come to people, and sometimes it comes to people in crisis. You say wholeness is never lost, it is only forgotten.

Dr. Remen: Wholeness includes all of our wounds. It includes all of our vulnerabilities. It is our authentic self, and it doesn’t sit in judgment on our wounds or our vulnerabilities. It simply says, “This is the way we connect to one another.” Often we connect through our wounds, through the wisdom we have gained, the growth that has happened to us. Because we have been wounded allows us to be of help to other people. So it’s not a moral judgment. Integrity simply means what is true, to live from the place in you that has the greatest truth. And that truth is always evolving as well.

[music: “Dawn” by Jacob Montague]

Ms. Tippett: Rachel Naomi Remen is founder of the Remen Institute for the Study of Health and Illness, clinical professor of family medicine at UCSF School of Medicine and professor of family medicine at the Boonshoft School of Medicine at Wright State University. Her beloved books include Kitchen Table Wisdom and My Grandfather’s Blessings.

We’re also so grateful for Micah Thor, Joe Kessler, and the people of Tech Guru; Emily Oberman and our stellar design partners at Pentagram; Tito Bottitta, Emily Theis, Andy Rader, Holly Copeland, Nick Braica, and all of the team at Upstatement; Keith Yamashita, and the people of SY Partners; and PRX — the Public Radio Exchange — including Kerri Hoffman, John Barth, Kathleen Unwin, Sean Nesbitt, Andrew Kuklewicz, and Paloma Orozco.

Special thanks to the 1440 Multiversity and all the people who applied, attended, or enjoyed our recordings from The On Being Gathering — an ongoing community and energy which was a particular joy of this past year.

We were also fortunate to partner with a range of extraordinary organizations including the Obama Foundation, the Union for Reform Judaism, The University of Montana–Missoula and Montana Public Radio, the United States Holocaust Memorial Museum, ArtReach St. Croix, B’Nai Jeshurun, Women Moving Millions, the St. Paul Chamber Orchestra, the Orange County Department of Education, the Geraldine R. Dodge Poetry Festival, The Solutions Journalism Network, and WNYC Studios’ Werk It Women’s Podcast Festival.

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